I am a plastic surgeon in Little Rock, AR. I used to "suture for a living", I continue "to live to sew". These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

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Monday, July 13, 2009

Updated 3/2017-- photos and all links (except to my own posts) removed
as many no longer active. and it was easier than checking each one.

Are breast cancers over-diagnosed? If so, how often? Those are the questions looked at by the systematic review of incidence reported data/articles done by Karsten Juhl Jørgensen & colleagues. Their results are published online in the June 9th issue of the British Medical Journal. Their review shows an estimated 52% over-diagnosis of breast cancer.

The researchers’ objective was to estimate the extent of over-diagnosis. Screening for breast cancer is meant to detect lethalcancers earlier. Unfortunately it also detects harmless ones that will not cause deathor symptoms. As it is not possible to distinguishbetween lethal and harmless cancers, all detected cancers aretreated. Over-diagnosis and overtreatment are therefore inevitable.

They begin their review of incidence reported data from 7 years before routine screening programs were implemented and 7 years after full screening was implemented. They included screened and non-screened age groups. Data was available from United Kingdom; Manitoba, Canada; New SouthWales, Australia; Sweden; and parts of Norway.

This data came from a PubMed search (May 2006) which yielded 2861 titles, 2546 of whichwere not relevant. That left 315articles which were evaluated. Four were included ascore articles and one was added when the search was updatedin April 2007, presenting data from the United Kingdom; Manitoba,Canada; New South Wales, Australia; Sweden; and parts of Norway. A meta analysis was done on the data.

Looking at the United Kingdom data, they found that the screening program began in 1988 for women aged 50-64. National coverage began by 1990. The screening was expanded to women aged 65-70in 2002. There was a 41% higher than expected rate of invasive cancer found in women aged 50-64 during the 1993-1999 period with no compensatory drop during the 7 yrs after full screening was implemented. This is interpreted as over diagnosis of breast cancer. This chart (photo credit) shows the incidence of invasive breast cancer per 100,000 women in UK.

This same trend was found in the data from the other countries. Combining the data, the researchers estimated 52% over diagnosis of breast cancer in a populations of women who are offered organized mammography screening. That amounts to one in three breast cancers being over diagnosed.

We need improved screening methods to decrease this number to less than 10% over-diagnosis. Each “un-necessary” surgery for one of the over-diagnosed cancers puts the patient at risk for complications. Not to mention the increased cost to the healthcare system of each country.

CA,they are ones that don't seem to progress and never end up being the cause of death even left untreated. As surgery carries it's own risk, it's trying to look at the balance of early diagnosis verse over diagnosis.

Think about doing appendectomies on patients who turn out to not have appendicitis.

This article isn't the end-all to the discussion, but we do need to look at it.

Good individualized medical advice can substantially improve the odds of a meaningful diagnosis since these statistical studies are averaged over all sorts of conditions and medical systems. However, as a worst case lets say that it's 50:50. In other words screening has a 50% chance of saving you from invasive breast cancer. Not getting screened is then equivalent to playing Russian Roulette with half the chambers filled with bullets. You can avoid screening, spin the chamber and you may be lucky or NOT. Does this kind of gamble make sense. Each untreated cancer puts the patient at risk for invasive life threatening cancer in half the cases! Treatments although of course undesired are improving all the time.

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My purpose in writing my blog is to attempt to provide good solid medical information on topics of my choosing. It is a way to educate myself, my colleagues, and the general public. References will be provided on medical posts, but not on opinion essays or poetry posts. An additional purpose is to share my interest in quilting topics, a way to show my human side.

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